SFD (0106-379)54290 Avenida Martinez
0106-379
d. LICENSED CONTRACTOR DECLARATION
J I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
r fgAonals Code, and my License is in full force and effect.
r Cicen'se # Lic. Class' f Exp. Date
ftto ryryq p
J/ {7. CYQ, of / 513,1/01"
/ -r !
Date/t!' ! Signature of -Contractors
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals CodeZ.
( ) I, as owner of the property, am exclus hely contracting with licensed
contractors to construct the project (Sec. 70A< Business & Professionals
Code). i '' •
() I am exempt under Section B8'9'P-for this reason
Date..Signature of Owner
r ,
WORKER'S COMPENSATION DECLARATION
I hereby affirm under `penalty of. perjury on of the following declarations:
() I have and will maintain a' certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which'this permitrslssued.
,V) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier ;, Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(' ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation__ laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I,shall forthwith comply with those provisions, /J
Date:. `./ Applicant.---' •,(-r.; .Cw }fi ' %
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil.fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions, set forth on. his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned_ property for inspectlon'purposes.
t$ignatu re (Owner/Agent)A ' Date
BUILDING PERMIT PERMT#
DATE J VALUATION LOTS. / - OUK-• f- ,TRACT
-
JOB SITE°
ADDRESS .544 , 9: Vi .,,i i:Y. %i d PA7n'WZ
PN
5
OWNER
CONTRACT PN?' INEER
14 02, aEAC00C HDA,
Of 7 50 ADAMS .,r,F f ?'3. 02213
SAI'Lk- ANA CI& 632705
LA QXURTA C.04 92259
(760)564-71320 4'.C3UI 02063
USE OF PERMIT
Mme►I RJA14 iWE.),INO
SYD, d:,0'I' 16.1,MC:C-1MAl~,i.UM, P3JRMIT OT.F4IdOT iMZ:LUDR, 3:II..00K
VIACT Colin -RUCTION UCTIV'N dtl /6i 1.00 S
irtCA,l?A°: /'8 ; ,4..9 r ...' .. t . ff•Q .G i`) 4$ '
08.00 Sri
5 FT. WOM MMWIE 200.W L'
ESTIMA ) MT Of CONS'3i;1ilUC°11014
108IM5.20
VEH. DE -1101,11T 01-NO.4:59-316 42.Moo
CIC'YN STRLBCTICYN FEZ 101-000-1418-000 $iS r"1.00
PLAW CIMIX FBII 101-000-439-318
M FC:,$a6t N IC,,,eA L ,F PX 101.000-42 i -0W Sx.0Y1
17LYWI i RIC':AL FFr,,.. 101.000.420«000 S12044
PL1#R9 INU ,fr M .101-ODO--419-000 $122.75
MONO MOTION FU - 1.01-04:0.241.000 $10,20
ffi1NsrM 11 0i _000.423-10 00 $710-000
D FLOyypQPA-C-T IF. 1110117.10
Xc, lS k?a Z?k 1.01-i1flG1•.r1 1- 1 A0.930
ri
IYM UOXAND Pl.,t+,lu CTMIK,,
D TAS3 PRE -PAD M3
4250.00
AUG 14 2002 rnmor:rns Dul, ow
OF LA CUINTA
,CITy
.-. FINANCE DEPT•
RECEIPT
DATE
/BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4— D57
Underground Ducts
Forms & Footings
� '
Ducts
Slab Grade
(D
Return Air
Steel
Combustion Air
Roof Deck
`!_ �s O /
5;r
Exhaust Fans
O.K. to Wrap/2(Q_�
`e
F.A.U.
Framing
Z
/�� /
-
Compressor
Insulation
_
/�
��
Vents
Fireplace P.L.
/
/
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
- GZ
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_ _
�/
_
S
Heater Final
Water Piping
/B
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
!O • p. O /
57
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
– /'7
Notice:
Document Cannot Be Duplicated
Date 8/13/01
No. 22372
Owner NameWilliam Doherty
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No, 54-290 Street Avenida Martinez
City La Quinta
Tract #
Type of Development
Comments
Lot # 16
Single Family Residence
APN # 774-254-003
Jurisdiction La Quinta
zip 92253
Square Footage
Permit # 0106-3 79
Log #
Study Area
1788
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05
X 1,788 or $ 3,665.40
the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued -
Fees Paid By CC / 1 st Bank - Sharon Bills
Telewone 760-564-7820
Name on the check
�- ■ T iM
By Dr. Doris Wilson
Superintendent
Fee collected /exem ted by Annette Barlow
Payment Received $3,665.40
Check No. 59175
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
9
010
Building
Address I I v C /1 }; 1 VCr/.7
{J '
Owner I
r,
t4)/c i-/
Mailing (J %
Address / / v c Chi(
City
A lA Ave z i7o t
Contractor ,
4 4 "
P.O. BOX 1504
1Gtr/(78-495 CALLE TAMPICO
1Gt I kA QUINTA, CALIFORNIA 92253
G ?` -) 6,2'e4
Addre
, `7') AD
C'ty Zip Tel.
State Lic. e— City
& Classif. ') Lic. #0, (j 3
Arch., Engr.,
Designer 4p
/-I CIq Cl r+ y7
Address Tel.
i7'(l3i
City Zip State
Lic. q
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I: I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
II I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i7 I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be .completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any persoh,in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to complywith all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip ,
8co -V 5qPaTy Paz
Pt,40 5
APPLICATION ONLY
BUILDING: TYPE'CONST. /_ OCC. GRP.
A.P. Number 6,07- /w
Legal Description -7-1 Li 2 S `! Y.o V
Project Description ' —a 1 SCJ L C 1 I L
L tuJGj1- M4t,IB #Z
t
Sq. Ft. 1 ' f (/
Size I Q LI
No. f No. Dw.
Stories /
Units
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
2; 3 --
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
e
n r- 01101
NCE DEP
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
W"SAA;
RECORDING REQUESTED BY:
OLD REPUBLIC TFTlF_ 00.
AND WHEN RECORDED, MAIL TO:
William J. Doherty
1402 Peacock Hill
Santa Ana, CA 82705
ASSESSOR'S PARCEL NO.: 774-254.003
TITLE ORDER Na.: 504491-13
ESCROW NO.: 6163.0$
GRANT ®EEC
7145478909; .Jun -20-01 10:24Atdl; Page 1
DOC a 2®®®--2 77®75 r j
07/18/2600 Itlli:00A Pw:9.0tD ` ' T 1
Pane f of R Coo T Torr Paid
Reaor4od in Officiai Records r
County of Riveralde J —Z cr D
Cary L. Orae
Rssessor, Coaniy Clark a Reaeraier
IIUIIII I I1 1#
M 9 U
PAGE
sin
C4
PW 11V00A
tiMF M r.
A R L
eeAv
oua aFcuuo
uc a xAu
The undersigned Grantor(s) declare that the DOCUMENT TRANS
TAX Is:
$ 25.85 County $ City
,Lcomputed on the full valve of the interest of property conveyed, or
computed on. the full value loss the value of (lens or encumbrances
remaining thereon at the time of sale.
!OR transfer Is EXEMPT from tax for the following mason,
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Richard J. Greco, a married- man as to an undivided 112 interest and David L. Davies, a married man as to an
Individed 112 Interest as"Tenants In common
hereby grants to William J. Doherty, Trustee of the William J. Doherty Revocable Trust Dated
January 30, 1997, as to an. undivided 50%..t,aterest and Patrick T. Doherty, a carried Ulan as
bas sole and - separate property, as to as undivided 50X serest. as tenants in coaleocm
all' -that real property situated In the City of Le Quints County of Riverside, State of California, described as.-
-Lot
s:
—Lot 16 O Block 301, Unit 27 in Santa Carmelite, at Vale La Quinta as per map recorded In Book 19, Page 82 of Maps in
the office of the County Recorder of said County.
Dated Junta 12, 2000
STATE OF CAL I
COUNTY OF
O N before me rl
Notary Pub110, personsily ppeared
personally known to m0 (or proved to me on the bassis of satisfactory evidence)
to be the perili<i*-whoss n I 1pserlbed to the within ins nt end
aoknwvledged to rrA .tha h y executed the sere I h r
authorized capaolty#* end i at wA* 6gneturs(4 on the instrument
the persor4* or the entity uprm of which the persof4Witeted, executed
the inatrurnent,
miNESS rtw%nile ri4 pirlctal r
MAIL TAX STATEMENTP TO:
William J. Doherty - 1 Peacock
CA 92705
44
ch rd I Gra
David L. Davies
TRACEY L PEM
Conwi!!On i 1221912
Wow Pt+b `
lowt brm>L I". sitt3ri mwa 74
4
(This area for official notary seal)
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INSTALLATION CERTIFICATE
CF -6R
Site Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
❑ DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, enter calculated value here
If fan flow is measured, enter measured value here
Leakage .Fraction = Test Leakage/(Measured or Calculated Fan Flow) = S s
Pass if leakage fraction <_ 0.06
❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections /
❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
❑
Yes is a pass
Pass Fail
❑ DUCT DESIGN
1 • ❑ Yes ❑ No ACCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation matches
plans.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1R.
Measured Fan Flow =
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in
conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF -6R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for
compliance credit.]
C id oZ , C' VL-
sts Signature, Date Installing Subcontractor (Co. Name) OR
Performed
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
January 4, 2001
General Contractor (Co. Name)